A 65-year-old man with a history of hypertension and nephrolithiasis presented with flank pain. Urographic CT demonstrated a 1.7-cm nodule arising from the bladder wall. The patient was referred for cystourethroscopy. During the procedure, the patient became hypertensive while under general anesthesia. No biopsy or resection was performed. To work up for possible bladder paraganglioma, a I-MIBG scan was ordered, and the patient was referred to endocrinology. On SPECT/CT images, the bladder nodule demonstrates marked uptake of MIBG radiotracer, confirming the diagnosis of a genitourinary paraganglioma arising from the bladder wall.